Assessing Fitness to Drive in Patients With Different Types of Dementia

Piersma, Dafne; Fuermaier, Anselm B. M.; Waard, Dick de; Davidse, R J; Groot, Jolieke De; Doumen, Michelle J. A.; Bredewoud, Ruud A.; Claesen, R.; Lemstra, Afina W.; Scheltens, Philip; Vermeeren, Annemiek; Ponds, Rudolf; Verhey, Frans R.J.; Deyn, Peter Paul De; Brouwer, Wiebo; Tucha, Oliver

doi:10.1097/wad.0000000000000221

Cited by 29 publications

(45 citation statements)

References 36 publications

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“…Yamin and colleagues reported that patients with mild DLB showed poorer performances than healthy controls in all parameters of a driving simulator ride, including an increased number of collisions . Moreover, on‐road fail rates of 40% and 35% are reported in very mild to mild disease stages, compared to 11% in healthy controls.…”

Section: Resultsmentioning

confidence: 99%

“…However, about half of these patients do not pass a practical driving test in early disease stages, compared to 11% in healthy controls. 37,39 In the non-Alzheimer syndromes, deficits in driving-relevant cognitive functions are frequent, whereas memory deficits may be less pronounced. 44,59,60 Importantly, this already applies to the prodromal stage of these syndromes, which is referred to as non-amnestic MCI.…”

Section: Non-alzheimer Dementiasmentioning

confidence: 99%

“…60,62 Both cognitive and noncognitive risk factors may severely impair driving skills in DLB; between 35% and 40% of these patients fail an on-road driving assessment in early disease stages, compared to 11% of healthy controls. 37,39 Parkinson disease dementia In PDD, cognitive symptoms particularly include deficits in attention, executive functions, and visuospatial abilities, 60 all of which appear to be closely connected to impaired driving fitness. 56 Similar to DLB, there are a number of noncognitive risk factors for driving safety as well, such as fatigue or extrapyramidal symptoms.…”

Section: Dementia With Lewy Bodiesmentioning

confidence: 99%

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Driving Fitness in Different Forms of Dementia: An Update

Toepper

Falkenstein

2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Most forms of dementia are associated with progressive cognitive and noncognitive impairments that can severely affect fitness to drive. Whether safe driving is still possible in the single case, however, is often difficult to decide and may be dependent on both severity and type of the respective dementia syndrome. Particularly in early disease stages, Alzheimer disease dementia (ADD) and different types of non‐Alzheimer dementias, such as vascular dementia (VaD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and Parkinson disease dementia (PDD), might differentially affect fitness to drive. DESIGN To examine the effects of severity and type of dementia on driving fitness, we conducted a systematic review with qualitative narrative synthesis, involving different driving outcomes in different forms and stages of dementia. SETTING Literature research included MEDLINE and PsycINFO databases with a focus on the most relevant and recent publications on the topic. PARTICIPANTS The population of interest included older drivers in different stages of ADD and different forms of non‐Alzheimer dementias (VaD, FTD, DLB, and PDD). MEASUREMENTS Narrative description of driving outcomes in the population of interest. RESULTS Overall, previous studies suggest that driving fitness is severely impaired in moderate and severe dementia, irrespective of the type of dementia. In milder disease stages, fitness to drive appears to be more severely impaired in non‐Alzheimer dementias than in ADD, since the non‐Alzheimer syndromes are not only associated with driving‐relevant cognitive but noncognitive risk factors, such as behavioral or motor symptoms. CONCLUSIONS Based on these findings, practical recommendations are presented, including a risk evaluation for driving safety, depending on severity and type of different dementia syndromes. J Am Geriatr Soc 67:2186–2192, 2019

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Section: Resultsmentioning

confidence: 99%

Section: Non-alzheimer Dementiasmentioning

confidence: 99%

Section: Dementia With Lewy Bodiesmentioning

confidence: 99%

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Driving Fitness in Different Forms of Dementia: An Update

Toepper

Falkenstein

2019

J American Geriatrics Society

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“…Nevertheless, with the progression of the disease, cognitive abilities needed for safe driving gradually decrease and driving cessation is likely to become inevitable [ 11 , 12 ]. It is difficult to define when a patient with dementia is no longer fit to drive [ 13 ] because of large individual differences in the patterns of dysfunctions, related to the different aetiologies of dementia [ 14 , 15 ]. Therefore, the most appropriate moment to cease driving needs to be assessed on a case-by-case basis [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

et al. 2018

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BackgroundDriving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility.MethodsPatients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated.ResultsRespectively 92 and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use.ConclusionsAdherence to the recommendations given after the fitness-to-drive assessments was high. Female patients were in general more likely to cease driving. However, a minority of patients did not adhere to driving cessation advice. These drivers with dementia should be made aware of the progression of their cognitive impairment and general health decline to facilitate driving cessation. There are large differences in mobility between patients with cognitive impairment. Physicians should discuss options for alternative transportation in order to promote sustained safe mobility of patients with cognitive impairment.

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“…Poor performance on cognitive assessments and decreased motor functioning have been associated with impaired driving in patients with HD (Devos et al 2012(Devos et al , 2014Hennig et al 2014). A recent study showed that specific assessments are necessary when evaluating driving competence in different types of dementia (Piersma et al 2018). Patients with HD who failed the on-road driving assessment also performed worse on driving simulator evaluations (Devos et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Altered driving performance of symptomatic Huntington’s disease gene carriers in simulated road conditions

Jacobs

Hart

Miranda

et al. 2018

Traffic Injury Prevention

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Objective: In clinical practice, patients with Huntington's disease (HD) often decide to solely drive in their own familiar neighborhoods and not on a motorway or in an unknown area. The aim of the study was to identify differences in driving performance between HD gene carriers and healthy individuals in simulated urban and motorway environments. Methods: This cross-sectional study included 87 participants (28 premanifest HD, 30 manifest HD, 29 controls). All participants were active drivers and were assessed using a driving simulator, a driving history questionnaire, and the Unified Huntington's Disease Rating Scale. The driving simulator session included urban and motorway scenarios. Analysis of variance and Kruskal-Wallis tests were used to compare urban and motorway driving across all 3 groups. Results: Manifest HD drove slower compared to controls and premanifest HD when speed limits increased (80 and 100 km/h) and they had a less steady speed compared to premanifest HD on the motorway and in a 30 km/h zone. Manifest HD also had a larger standard deviation of the lateral position (i.e., more weaving of the car/less vehicle control) compared to controls and premanifest HD on the motorway. Conclusions: Manifest HD drive more cautious in a driving simulator when speed limits increase compared to premanifest HD and controls and they have less vehicle control on the motorway. The driving simulator parameters are able to discriminate between manifest HD and healthy individuals, so a driving simulator seems a feasible tool to use when investigating changes in driving in manifest HD. ARTICLE HISTORY

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Assessing Fitness to Drive in Patients With Different Types of Dementia

Cited by 29 publications

References 36 publications

Driving Fitness in Different Forms of Dementia: An Update

Driving Fitness in Different Forms of Dementia: An Update

Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

Altered driving performance of symptomatic Huntington’s disease gene carriers in simulated road conditions

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